Remote Senior Nurse Reviewer – Claims & Utilization Expert

Jobgether SRL; United States; Remote; USD 78,000 - 99,000; Full time

Benefits offered by this job

Salary range 78k–99k USD

Remote work

401(k) plan

Comprehensive health benefits

Educational assistance

Leadership development academies

Professional growth opportunities

Job summary

Jobgether SRL, listing on behalf of a partner, seeks a Senior Nurse Reviewer based in the United States. You will evaluate medical records, claims, UB-04 forms, and itemized bills to ensure accurate billing and appropriate levels of care using established criteria.

This remote role combines clinical analysis with utilization review and claims auditing. You will mentor other reviewers, participate in training, and maintain knowledge of coding guidelines and policies while meeting production and

Qualifications

• Active, unrestricted RN license in the United States and state of residence.
• At least 5 years of clinical experience in an inpatient hospital setting.
• At least 1 year of itemized medical bill review experience.
• Familiarity with CPT, ICD-10, and HCPCS coding guidelines.

Responsibilities

• Review medical claims using UB-04 forms and itemized statements to validate charges.
• Verify itemized charges against client policies and industry standards.
• Perform utilization and level-of-care reviews using established criteria.
• Assess medical necessity by evaluating clinical documentation.
• Mentor and train new reviewers through daily monitoring and feedback.
• Maintain current knowledge of clinical policies, coding guidelines, and regulations.
• Complete CEUs to maintain an active nursing license.
• Cross-train across multiple claim types to support flexibility.

Skills

RN license

Clinical experience

Critical thinking

Tools

CPT/ICD-10 guidelines

Job description

Jobgether SRL, listing on behalf of a partner, seeks a Senior Nurse Reviewer based in the United States. You will evaluate medical records, claims, UB-04 forms, and itemized bills to ensure accurate billing and appropriate levels of care using established criteria.

This remote role combines clinical analysis with utilization review and claims auditing. You will mentor other reviewers, participate in training, and maintain knowledge of coding guidelines and policies while meeting production and